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Applicant <br />Owner <br />Little Canada, Minnesota <br />APPLICATION FORM <br />111. <br />PAID le 7DC) <br />Rec. No <br />Comprehensive Plan Amendment Conditional Use Permit <br />Zoning District Amendment Variance <br />Text Amendment Subdivision <br />Other Planned Unit Development <br />Plan Review <br />kc k. ¶S d j <br />(Name) <br />ISZ.v ;ri Vickers <br />(Name) <br />2.3s- s- rv;ew Ave 7— S-0 <br />(Address) Ros%v/ rl 5-5-7r3 <br />Property Location (Street Address and Legal Description): <br />-- 7S DQono '4v& Chsr � <br />(Address) <br />L r-rc 4 CA-A,,444 ,¼4N1 <br />6 +2 4,lb <br />(Phone) <br />(0s1 S92. 30(.93 <br />(Phone) <br />SSr1'7 <br />/51/2 <br />fio# tietekt.js Lors Z1 77nry 3r 13/0c.4_ <3 Ly;� j t,�.0F 0.I <br />9r P A-+v d 5 5 r F 01 /L;' / u/ <br />Description and /or Reason for Request (Cite Ordinance Sections): <br />. u bchvrsb oN of g-t; sT;,vq <br />In signing this application, I hereby acknowledge that I have read and fully understand the applicable provisions of the Zon- <br />inn and Subdivision Ordinances and current administrative procedures. I further acknowledge the fee explanation as outlined <br />i e application procedures and hereby agree to pay all statements received from the City pertaining to additional applica- <br />tion expense. <br />(Sign,rs of Applicant) <br />WHITE— Office CANARY — Customer PINK —File GOLD—Planner - • <br />(Date) <br />